Surgical management of traumatic diaphragmatic hernia: a single institutional experience of more than two decades

Abstract Background We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality. Methods A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990–2005, 2005–2017) divided by introduction of computed tomography at our institution. Results The overall mean age was 31.2 ± 16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the second group (2005–2017) yet none in the first group (1990–2005) underwent computed tomography. Ten patients (15.9%), of which 8 in the first and the other 2 in the second group (p = .042), had late diagnoses. The most commonly used incision was a thoracotomy (n = 43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than non-survivors. By multivariate logistic regression analysis, increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were risk factors of death in all patients. Conclusions High-definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced ages are at a higher risk of death.

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Surgical Management of Traumatic Diaphragmatic Hernia: a Single Institutional Experience of More Than Two Decades.

10.21203/rs.3.rs-126083/v1 ◽

2020 ◽

Author(s):

Xicheng Deng ◽

Zuosheng Deng ◽

Erjia Huang

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Surgical Management ◽

Diaphragmatic Hernia ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Penetrating Trauma ◽

Traumatic Diaphragmatic Hernia ◽

Risk Of Death ◽

Severity Scores

Abstract Background: We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality. Methods: A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990-2005, 2005-2017) divided by introduction of computed tomography at our institution.Results: The overall mean age was 31.2±16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the latter period yet none in the former period underwent computed tomography. Ten patients (15.9%), of which 8 in the former and the other 2 in the latter period (p=.042), had late diagnoses. The most commonly used incision was a thoracotomy (n=43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than nonsurvivors. By multiple logistic regression analysis, increased age (odds ratio, 1.275; p=.013) and greater ISS (OR, 1.174; p=.028) were risk factors of death in all patients.Conclusions: High definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced age are at higher risk of death.

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A population-based exposure assessment of risk factors associated with gastrointestinal pathogens: a Campylobacter study

Epidemiology and Infection ◽

10.1017/s0950268812001641 ◽

2012 ◽

Vol 141 (5) ◽

pp. 976-986 ◽

Cited By ~ 8

Author(s):

L. A. MacRITCHIE ◽

C. J. HUNTER ◽

N. J. C. STRACHAN

Keyword(s):

Risk Factors ◽

Population Density ◽

Exposure Assessment ◽

Disease Incidence ◽

Univariate Analysis ◽

Age Groups ◽

Multivariate Logistic Regression Analysis ◽

Environmental Water ◽

Population Based ◽

Elevated Exposure

SUMMARYA questionnaire survey was undertaken to determine the exposure of a study population to campylobacteriosis source risk factors (environmental, water, food) and results were stratified by age, population density and deprivation. Data were gathered using an exposure assessment carried out by telephone in the Grampian region of Scotland. Univariate analysis showed that children aged 5–14 years, living in low population density (0–44·4 persons/km2) and affluent areas had elevated exposure to environmental and water risk factors. Multivariate logistic regression analysis revealed that younger age groups and lower population density were significant indicators for most environmental risk factors. The results compared to reported disease incidence in Grampian showed that greater exposure to risk factors does not necessarily coincide with greater disease incidence for age groups, particularly for the 0–4 years age group. Further research is required to explain the relationship between exposure and disease incidence.

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Factors associated with COVID-19 related hospitalisation, critical care admission and mortality using linked primary and secondary care data

10.1101/2021.01.19.20241844 ◽

2021 ◽

Author(s):

Lisa Cummins ◽

Irene Ebyarimpa ◽

Nathan Cheetham ◽

Victoria Tzortziou Brown ◽

Katie Brennan ◽

...

Keyword(s):

Risk Factors ◽

Learning Disabilities ◽

Secondary Care ◽

Multivariate Logistic Regression Analysis ◽

Additional Patient ◽

Factors Associated ◽

Icu Admission ◽

Risk Of Death ◽

North East ◽

Increased Risk

AbstractBackgroundTo identify risk factors associated with increased risk of hospitalisation, intensive care unit (ICU) admission and mortality in inner North East London (NEL) during the first UK COVID-19 wave.MethodsMultivariate logistic regression analysis on linked primary and secondary care data from people aged 16 or older with confirmed COVID-19 infection between 01/02/2020-30/06/2020 determined odds ratios (OR), 95% confidence intervals (CI) and p-values for the association between demographic, deprivation and clinical factors with COVID-19 hospitalisation, ICU admission and mortality.ResultsOver the study period 1,781 people were diagnosed with COVID-19, of whom 1,195 (67%) were hospitalised, 152 (9%) admitted to ICU and 400 (23%) died. Results confirm previously identified risk factors: being male, or of Black or Asian ethnicity, or aged over 50. Obesity, type 2 diabetes and chronic kidney disease (CKD) increased the risk of hospitalisation. Obesity increased the risk of being admitted to ICU. Underlying CKD, stroke and dementia in-creased the risk of death. Having learning disabilities was strongly associated with increased risk of death (OR=4.75, 95%CI=(1.91,11.84), p=0.001). Having three or four co-morbidities increased the risk of hospitalisation (OR=2.34,95%CI=(1.55,3.54),p<0.001;OR=2.40, 95%CI=(1.55,3.73), p<0.001 respectively) and death (OR=2.61, 95%CI=(1.59,4.28), p<0.001;OR=4.07, 95% CI= (2.48,6.69), p<0.001 respectively).ConclusionsWe confirm that age, sex, ethnicity, obesity, CKD and diabetes are important determinants of risk of COVID-19 hospitalisation or death. For the first time, we also identify people with learning disabilities and multi-morbidity as additional patient cohorts that need to be actively protected during COVID-19 waves.

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Risk Factors for Mortality in Patients with Elizabethkingia Infection and the Clinical Impact of the Antimicrobial Susceptibility Patterns of Elizabethkingia Species

Journal of Clinical Medicine ◽

10.3390/jcm9051431 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1431 ◽

Cited By ~ 1

Author(s):

Hye Seong ◽

Jung Ho Kim ◽

Jun Hyoung Kim ◽

Woon Ji Lee ◽

Jin Young Ahn ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Antimicrobial Susceptibility ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Intrinsic Resistance ◽

Albumin Ratio ◽

Saps Ii ◽

Saps Ii Score ◽

Susceptibility Patterns

Elizabethkingia species (spp.), which can colonize hospital environments, are emerging nosocomial pathogens presenting high mortality. Due to their intrinsic resistance to a broad range of antibiotics, optimal antibiotic dosage has yet to be determined against infections caused by Elizabethkingia spp. This study aimed to investigate the risk factors for the mortality of infections caused by Elizabethkingia spp. and assess the clinical implications of their antimicrobial susceptibility patterns. Data from 210 patients affected by Elizabethkingia-induced pneumonia and bacteremia between 1 November 2005 and 31 May 2016, were analyzed. Further antimicrobial susceptibility tests for moxifloxacin, rifampin, and vancomycin using Elizabethkingia isolates were performed to compensate for the Elizabethkingia spp. susceptibility panel in patients affected after 2013. The mean age of the patients was 66.5 ± 18 years and the 28-day mortality rate was 25.2% (53/210). In the univariate analysis, history of prior stay in an intensive care unit, central venous catheter use, presented thrombocytopenia, immunocompetent status, a high simplified acute physiology score II (SAPS II score), a high C-reactive protein (CRP)/albumin ratio on the day of isolation and seven days later, and a high minimum inhibitory concentration (MIC) value of rifampin were significantly associated with a higher mortality rate. In the multivariate logistic regression analysis, the MIC values of rifampin (odds ratio (OR): 1.045; 95% confidence interval (CI): 1.006–1.085; p = 0.023), SAPS II score (OR: 1.053; 95% CI: 1.022–1.084; p = 0.001), and initial CRP/albumin ratio (OR: 1.030; 95% CI: 1.009–1.051; p = 0.004) were significantly associated with 28-day mortality. To reduce the mortality associated with Elizabethkingia infections, prediction of the clinical course using initial CRP/albumin ratio and SAPS II and early intervention are essential. Rifampin is a promising candidate as the drug of choice in treating Elizabethkingia infections.

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Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a prospective multicentre follow-up study

Annals of the Rheumatic Diseases ◽

10.1136/ard.2010.142042 ◽

2011 ◽

Vol 70 (6) ◽

pp. 1083-1086 ◽

Cited By ~ 104

Author(s):

Amelia Ruffatti ◽

Teresa Del Ross ◽

Manuela Ciprian ◽

Maria T Bertero ◽

Sciascia Salvatore ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Univariate Analysis ◽

Thrombotic Event ◽

Multivariate Logistic Regression Analysis ◽

Antiphospholipid Antibody ◽

History Of ◽

Ischaemic Attack ◽

Independent Risk Factors

ObjectivesTo assess risk factors for a first thrombotic event in confirmed antiphospholipid (aPL) antibody carriers and to evaluate the efficacy of prophylactic treatments.MethodsInclusion criteria were age 18–65 years, no history of thrombosis and two consecutive positive aPL results. Demographic, laboratory and clinical parameters were collected at enrolment, once a year during the follow-up and at the time of the thrombotic event, whenever that occurred.Results258 subjects were prospectively observed between October 2004 and October 2008. The mean±SD follow-up was 35.0±11.9 months (range 1–48). A first thrombotic event (9 venous, 4 arterial and 1 transient ischaemic attack) occurred in 14 subjects (5.4%, annual incidence rate 1.86%). Hypertension and lupus anticoagulant (LA) were significantly predictive of thrombosis (both at p<0.05) and thromboprophylaxis was significantly protective during high-risk periods (p<0.05) according to univariate analysis. Hypertension and LA were identified by multivariate logistic regression analysis as independent risk factors for thrombosis (HR 3.8, 95% CI 1.3 to 11.1, p<0.05, and HR 3.9, 95% CI 1.1 to 14, p<0.05, respectively).ConclusionsHypertension and LA are independent risk factors for thrombosis in aPL carriers. Thromboprophylaxis in these subjects should probably be limited to high-risk situations.

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Toxoplasma gondii antibodies and related risk factors in mammals at Sorocaba zoo, São Paulo, BrazilToxoplasma gondii antibodies and related risk factors in mammals at Sorocaba zoo, São Paulo, Brazil

Semina Ciências Agrárias ◽

10.5433/1679-0359.2017v38n4supl1p2845 ◽

2017 ◽

Vol 38 (4Supl1) ◽

pp. 2845

Author(s):

Renata Bezerra Marujo ◽

Helio Langoni ◽

Leila Sabrina Ullmann ◽

Maysa Pellizzaro ◽

Ramiro Das Neves Dias Neto ◽

...

Keyword(s):

Risk Factors ◽

Toxoplasma Gondii ◽

Feeding Habits ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Sao Paulo ◽

São Paulo ◽

Intermediate Hosts ◽

Serum Samples ◽

Related Risk

Toxoplasmosis is a parasitic zoonosis with worldwide distribution and different wild species either are involved in maintenance of the pathogen in the environment as definitive or intermediate hosts serving as font of feeding or prey to definitive hosts. The present study aimed to investigate Toxoplasma gondii antibodies and the risk factors relating to infection in mammals at Sorocaba Zoo, state of São Paulo, Brazil. Serum samples collected from 153 animals were analyzed using the modified agglutination test (MAT; cutoff ? 25). Seropositivity was found in 62 animals (40.5%; 95% CI: 33.1-48.5%), with different titers. Significant differences were observed in relation to the ages of the animals, origin, presence of free-ranging animals in the enclosure and feeding habits, through univariate analysis (p ? 0.05). Multivariate logistic regression analysis showed that only age (p = 0.03) had significance for the study. Adult animals were 3.5 more likely to become infected than were young ones. In relation to feeding habits, herbivores (80%) and carnivores (46.5%) were the animals most affected. These results highlight the presence of T. gondii in animals at Brazilian zoos, and suggest that continuous transmission is occurring at zoos.

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Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography

Cardiovascular Research ◽

10.1093/cvr/cvaa193 ◽

2020 ◽

Vol 116 (14) ◽

pp. 2239-2246 ◽

Cited By ~ 3

Author(s):

Giuseppe Ferrante ◽

Fabio Fazzari ◽

Ottavia Cozzi ◽

Matteo Maurina ◽

Renato Bragato ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Cohort Study ◽

Myocardial Injury ◽

Troponin I ◽

Cox Regression ◽

Chest Ct ◽

Chest Computed Tomography ◽

Risk Of Death ◽

Increased Risk

Abstract Aims Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19. Methods and Results This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I >20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th–75th percentile, 27–32) mm vs. 27.7 (25–30) mm, P < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02–1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02–1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27–3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death. Conclusions An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.

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Risk Factors for and Outcomes Associated with Clinical Isolates ofEscherichia coliandKlebsiellaSpecies Resistant to Extended-Spectrum Cephalosporins among Patients Admitted to Canadian Hospitals

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2009/725872 ◽

2009 ◽

Vol 20 (3) ◽

pp. e43-e48 ◽

Cited By ~ 11

Author(s):

Marianna Ofner-Agostini ◽

Andrew Simor ◽

Michael Mulvey ◽

Alison McGeer ◽

Zahir Hirji ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Care Facility ◽

P Value ◽

Third Generation ◽

Multivariate Logistic Regression ◽

Extended Spectrum ◽

Third Generation Cephalosporins

BACKGROUND: Clinical features associated with Gram-negative bacterial isolates with extended-spectrum beta-lactamase (ESBL)- and AmpC-mediated resistance identified in Canadian hospitals is largely unknown. The objective of the present study was to determine the demographics, risk factors and outcomes of patients with ESBL- or AmpC-mediated resistant organisms in Canadian hospitals.METHODS: Patients with clinical cultures ofEscherichia coliorKlebsiellaspecies were matched with patients with a similar organism but susceptible to third-generation cephalosporins. Molecular identification of the AmpC or ESBL was determined using a combination of polymerase chain reaction and sequence analysis. Univariate and multivariate logistic regression analysis was performed to identify variables associated with becoming a case.RESULTS: Eight Canadian hospitals identified 106 cases (ESBL/AmpC) and 106 controls. All risk factors identified in the univariate analysis as a predictor of being an ESBL/AmpC cases at the 0.20 P-value were included in the multivariate analysis. No significant differences in outcomes were observed (unfavourable responses 17% versus 15% and mortality rates 13% versus 7%, P not significant). Multivariate logistic regression found an association of becoming an ESBL/AmpC case with: previous admission to a nursing home (OR 8.28, P=0.01) or acute care facility (OR 1.96, P=0.03), length of stay before infection (OR 3.05, P=0.004), and previous use of first-generation cephalosporins (OR 2.38, P=0.02) or third-generation cephalosporins (OR 4.52, P=0.01). Appropriate antibiotics were more likely to be given to controls (27.0% versus 13.3%, P=0.05) and number of days to appropriate antibiotics was longer for cases (median 2.8 days versus 1.2 days, P=0.05).CONCLUSION: The importance of patient medical history, present admission and antibiotic use should be considered for allE coliorKlebsiellaspecies patients pending susceptibility testing results.

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Risk factors for periprocedural ischemic stroke following endovascular treatment of intracranial aneurysms

Chinese Neurosurgical Journal ◽

10.1186/s41016-021-00255-z ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yisen Zhang ◽

Chao Wang ◽

Zhongbin Tian ◽

Wei Zhu ◽

Wenqiang Li ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Treatment Modality ◽

Intracranial Aneurysms ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Flow Diverter ◽

Multivariate Logistic Regression

Abstract Background The aim of this study was to comprehensively evaluate the risk factors of periprocedural ischemic stroke associated with endovascular treatment of intracranial aneurysms using a real-world database. Methods From August 2016 to March 2017, 167 patients were enrolled. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors for periprocedural ischemic stroke. Results Among the 167 cases, periprocedural ischemic stroke occurred in 20 cases (11.98%). After univariate analysis, the ischemic group had a higher proportion of large (≥ 10 mm) aneurysms than the control group (45.0% vs. 23.1%, p = 0.036). The incidence of periprocedural ischemic stroke was higher in cases treated by flow diverter (21.6%) or stent-assisted coiling (11.8%) than in cases treated by coiling only (2.7%), and the differences were statistically significant (p = 0.043). After multivariate logistic regression analysis, treatment modality was the independent risk factor for periprocedural ischemic stroke. Compared with the coiling-only procedure, flow diverter therapy was associated with a significantly higher rate of periprocedural ischemic stroke (OR 9.931; 95% CI 1.174–84.038; p = 0.035). Conclusions Aneurysm size and treatment modality were associated with periprocedural ischemic stroke. Larger aneurysms were associated with increased risk of periprocedural ischemic stroke. Flow diverter therapy was associated with significantly more periprocedural ischemic stroke than the coiling procedure alone.

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